Objective: To investigate the outcome in children perinatally infected with HIV-1 whose mothers received zidovudine (ZDV) monotherapy in pregnancy. Design: Observational retrospective study of a prospectively recruited cohort. Setting: Italian Register for HIV Infection in Children. Patients: A group of 216 children perinatally infected with HIV-1, born in 1992-1997 and derived prospectively from birth: 38 children had mothers receiving ZDV monotherapy and for 178 children the mothers received no antiretroviral treatment during pregnancy. Main outcome measures: The estimated probability of developing severe disease or severe immune suppression, survival probability [95% confidence interval (CI)] within 3 years, and the hazard ratio (95% CI), adjusted for year of birth, maternal clinical condition at delivery, birthweight and treatments (Pneumocystis carinii pneumonia chemoprophylaxis and/or antiretroviral therapy before the onset of severe disease, severe immune suppression or death) were compared. Results: Comparison of HIV-1-infected children whose mothers were treated with ZDV with children whose mothers were not treated showed that the former group had a higher probability of developing severe disease [57.3% (95% CI 40.9-74.3) versus 37.2% (95% CI 30.0-45.4); log-rank test 7.83, P = 0.005; adjusted hazard ratio 1.8 (95% CI 1.1-3.1)] or severe immune suppression [53.9% (95% CI 36.3-73.5) versus 37.5% (95% CI 30.0-46.2); log-rank test 5.58, P = 0.018; adjusted hazard ratio 2.4, (95% CI: 1.3-4.3)] and a lower survival [72.2% (95% CI 50.4-85.7) versus 81.0% (95% CI 73.7-86.5); log-rank test 4.23, P = 0.039; adjusted hazard ratio of death 1.9 (95% CI 1.1-3.6)]. Conclusions: This epidemiological observation could stimulate virologic studies to elucidate whether this rapid progression depends on in utero infection or transmission of resistant virus. Findings may suggest a need to hasten HIV-1 diagnosis in infants of ZDV-treated mothers and undertake an aggressive antiretroviral therapy in those found to be infected.

Rapid disease progression in HIV-1 perinatally infected children born to mothers receiving zidovudine monotherapy during pregnancy

CONSOLINI, RITA
1999-01-01

Abstract

Objective: To investigate the outcome in children perinatally infected with HIV-1 whose mothers received zidovudine (ZDV) monotherapy in pregnancy. Design: Observational retrospective study of a prospectively recruited cohort. Setting: Italian Register for HIV Infection in Children. Patients: A group of 216 children perinatally infected with HIV-1, born in 1992-1997 and derived prospectively from birth: 38 children had mothers receiving ZDV monotherapy and for 178 children the mothers received no antiretroviral treatment during pregnancy. Main outcome measures: The estimated probability of developing severe disease or severe immune suppression, survival probability [95% confidence interval (CI)] within 3 years, and the hazard ratio (95% CI), adjusted for year of birth, maternal clinical condition at delivery, birthweight and treatments (Pneumocystis carinii pneumonia chemoprophylaxis and/or antiretroviral therapy before the onset of severe disease, severe immune suppression or death) were compared. Results: Comparison of HIV-1-infected children whose mothers were treated with ZDV with children whose mothers were not treated showed that the former group had a higher probability of developing severe disease [57.3% (95% CI 40.9-74.3) versus 37.2% (95% CI 30.0-45.4); log-rank test 7.83, P = 0.005; adjusted hazard ratio 1.8 (95% CI 1.1-3.1)] or severe immune suppression [53.9% (95% CI 36.3-73.5) versus 37.5% (95% CI 30.0-46.2); log-rank test 5.58, P = 0.018; adjusted hazard ratio 2.4, (95% CI: 1.3-4.3)] and a lower survival [72.2% (95% CI 50.4-85.7) versus 81.0% (95% CI 73.7-86.5); log-rank test 4.23, P = 0.039; adjusted hazard ratio of death 1.9 (95% CI 1.1-3.6)]. Conclusions: This epidemiological observation could stimulate virologic studies to elucidate whether this rapid progression depends on in utero infection or transmission of resistant virus. Findings may suggest a need to hasten HIV-1 diagnosis in infants of ZDV-treated mothers and undertake an aggressive antiretroviral therapy in those found to be infected.
1999
Author: de, Martino; M, Galli; L, Tovo; Pa, Gabiano; C, Zappa; M, ; Group Author: Italian Register HIV Infect Children Italian Register:, Osimani; P, Zizzadoro; P, ; De, Mattia; D, Ruggeri; M, Lanari; M, ; Dalla, Vecchia; S, Masi; M, Baldi; F, Battisti; L, Duse; M, Crispino; P, Uberti; E, Bresciani; E, Chiriacò; Pg, Pintor; C, Dedoni; M, Loriano; D, Dessi; C, Anastasio; L, Sabatino; G, Sticca; M, Berrino; R, Lodato; A, Vierucci; A, Farina; S, ; De, Luca; M, ; De, Maria; A, Fioredda; F, Boni; S, Marazzi; Mg, Pontali; E, Forni; Gi, Gotta; C, Tasso; L, Gambaretto; G, Meo; A, Plebani; A, Pinzani; R, Salvini; F, Marchisio; P, Massironi; E, Tornaghi; R, Zuccotti; Gv, Riva; S, ; De, Carlis; S, Ferraris; G, Bucceri; A, Liprieri; R, Cellini; M, Guarino; A, Pignata; C, Tarallo; L, Giaquinto; C, Ruga; E, Rampon; O, Romano; A, Benaglia; G, Caselli; D, Maccabruni; A, ; Consolini, Rita
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/166989
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